2022 – 2023
Anna Hung, PharmD, PhD, MS – Duke University
Impact of Medication Therapy Management for Potentially Inappropriate Medications
Evidence Gap This Study Seeks to Address: Potentially inappropriate medication (PIM) use in Medicare Part D populations with multiple chronic conditions is extensive and expensive. Medication therapy management (MTM) is mandated for Medicare Part D plans nationwide, representing an opportunity to address wide-scale PIM use. However, little is known about the nationwide impacts of MTM on PIM use.
Primary Study Aims:
Aim 1) Examine patient characteristics associated with MTM comprehensive medication review (CMR) uptake in community-dwelling Medicare Part D beneficiaries with multiple chronic conditions. Aim 2) Assess MTM CMR’s impact on PIM use and whether it varies by race and ethnicity. Aim 3) Identify areas of improvement by describing the prevalence of and proportion filling the top 20 most commonly filled PIMs after MTM CMR receipt overall and by race and ethnicity
Study Design: Retrospective cohort study of community-dwelling Part D beneficiaries using Medicare fee-for-service administrative claims data and a sequential stratification matching design. This study is guided by a Stakeholder Advisory Board, which consists of a patient, a caregiver, a MTM pharmacist, a MTM vendor, a geriatrician, and a Medicare Part D quality measure developer.
Lauren Hunt, PhD, RN, FNP – UCSF
Evidence Gap This Study Seeks to Address: Efforts to clarify best practices for antidementia prescribing in hospice and associated payment and regulatory oversight for these medications are sorely needed. Previous work indicates that up to 30% of hospice enrollees continue antidementia drugs in hospice, but existing studies are limited by the fact that they were not specific to people with dementia, did not distinguish between people who were admitted to hospice for (principal) versus with (co-existing) dementia, did not include all possible data sources (i.e. both Medicare Part D and hospice-covered medications), or were based on provider recall.
Primary Study Aims:
Aim 1) Compare the proportion of people with a principal vs. a co-existing dementia diagnosis who continue antidementia medications in hospice and determine primary payment coverage (hospice provider or Medicare Part D). Aim 2) Identify patient sociodemographic and clinical characteristics (e.g., age, gender, race and ethnicity, comorbidities, setting of care) associated with continuation of antidementia medications.
Study Design: This study comprises a retrospective cohort analysis using Medicare data, building upon a dataset for which the research team already has an existing data use agreement with the Centers for Medicare and Medicaid Services (CMS). This dataset includes all Medicare claims (inpatient, outpatient, skilled nursing, etc.) and assessment files for a 100% cohort of hospice enrollees with dementia, 2012-2018, to which the research team will add Part D data files. Use of multivariate regression models will estimate the likelihood of (dis)continuing antidementia medications and patient-level predictors of continued use.
Evidence Gap This Study Seeks to Address: Currently, there is limited knowledge on attitudes or views of deprescribing and non-pharmacological pain management among older adults experiencing multiple morbidities and symptoms of pain as well as differences in such attitudes or views by sociodemographic factors including any racial or geographic differences.
Primary Study Aims: Aim 1) Assess attitudes toward deprescribing and knowledge and views of non-pharmacological pain management among community-dwelling older adults who have multiple chronic health conditions and experience chronic pain; Aim 2) Examine any differences in the attitudes/knowledge/views by demographic/socioeconomic/health factors; Aim 3) Explore their concerns about medications and views of deprescribing and non-pharmacological pain management; Aim 4) Explore their needs in deprescribing decision-making
Study Design: This study adopts a mixed-methods design: 1) a cross-sectional survey to collect demographic/socioeconomic/health information and assess attitudes toward deprescribing and knowledge and views of non-pharmacological pain management among community-dwelling older adults (65+) with two or more chronic illnesses and chronic pain and 2) in-depth interviews to collect qualitative data on a) their concerns about medications including pain medicine, b) their views of deprescribing and non-pharmacological pain management, including barriers and facilitators, and c) their needs in making decisions regarding deprescribing and non-pharmacological pain management.
Carina Lundby MScPhm PhD (University of Southern Denmark) and Wade Thompson PharmD PhD (University of British Columbia)
Evidence Gap This Study Seeks to Address:Quality of life (QoL) has been identified as an important outcome for deprescribing trials. Despite its importance, QoL is not always measured in deprescribing trials and when it is, a change/improvement is usually not demonstrated. This may be, in part, because it is unclear how QoL can be best captured in deprescribing research, for example, which QoL scales are most appropriate or which constructs/domains are most responsive to medication changes. Deprescribing researchers and trialists may also be hesitant to measure QoL due to practical concerns: it can be difficult, time-consuming, and expensive. Further, when QoL is measured, it is usually not a primary outcome, limiting the ability to detect an effect of deprescribing on QoL.
Primary Study Aims: Aim 1) Explore how best to measure QoL when conducting deprescribing clinical trials. This will be achieved this with three subaims: (1) conduct an in-depth examination of how QoL has been measured in deprescribing research to date, (2) explore patient perspectives on measuring QoL in deprescribing research, and (3) report the most promising QoL scales to further pursue for future deprescribing trials.
Study Design: This study has 3 objectives. Objective 1: Perform a scoping review to identify QoL scales used in deprescribing research to date and describe their characteristics. Objective 2: Interview older patients with polypharmacy to explore what QoL means to them in relation to having medications deprescribed and will examine the face validity of the existing QoL scales in a deprescribing context. Objective 3: Guided by findings from Objectives 1 and 2, the research team will conduct a consensus process with patients/carers and researchers with expertise in designing and conducting deprescribing trials to determine the most promising scale(s) and approaches to use for measuring QoL in deprescribing trials, and/or explore the need to adapt or design new scales.
Evidence Gap This Study Seeks to Address: Nearly one in three older adults report chronic pain, many of whom have been prescribed chronic opioid medications. While there has been substantial media attention focused on the opioid epidemic, there is little information for older adults who have been using opioids for a long time and their doctors on balancing the benefits of pain control with increasing risks of using opioids as patients age.
Primary Study Aims: Aim 1) Conduct qualitative interviews with older adults taking opioids for chronic pain to better understand older adults’ experiences with chronic opioid use, perceived benefits and risks of continued use, willingness to deprescribe, and past deprescribing experiences. Aim 2) Conduct qualitative interviews to understand clinicians’ experiences discussing opioid deprescribing with older adults with chronic pain and multimorbidity.
Study Design: This study consists of semi-structured interviews with 30 older adults receiving opioids for chronic pain and 20 ambulatory clinicians who care for older adults with chronic pain.